Multiple Sclerosis (MS) is a chronic autoimmune disease that primarily affects the central nervous system. This disease causes the immune system to abnormally attack the myelin sheath of peripheral nerves, leading to impaired nerve signal transmission and triggering a variety of neurological symptoms. Approximately 2.5 million people worldwide are affected by this disease, with a peak onset age between 20 and 50 years, and the proportion of female patients is about twice that of males.
The disease course exhibits high variability; some patients may experience temporary relief of symptoms, while others may continue to deteriorate. Currently, there is no cure, but early diagnosis and treatment can effectively delay disease progression and improve quality of life. Recent studies have shown that vitamin D intake and geographical factors are related to the risk of onset, indicating that the etiology of this disease involves complex interactions between genetic and environmental factors.
The key mechanism of multiple sclerosis lies in the immune system mistakenly identifying the nerve myelin as foreign, continuously launching attacks that lead to myelin damage (known as demyelination). This destruction forms plaque-like lesions, which can severely damage the nerve fibers themselves. Scientists believe that this abnormal response may be related to the abnormal recognition ability of T lymphocytes, but the specific triggering mechanisms remain unclear.
A family history is an important risk factor; when one identical twin is affected, the other twin's risk is 20 to 30 times higher than that of the general population. Specific variants of human leukocyte antigen (HLA) genes are highly associated with the onset of the disease. Environmental factors such as vitamin D deficiency, specific viral infections (such as Epstein-Barr virus), and a history of living in high-latitude areas have all been confirmed to be associated with an increased risk of onset.
The diversity of symptoms is a characteristic of this disease; about 85% of patients will experience unilateral blurred vision or unstable vision in both eyes upon first onset, known as optic neuritis. Motor function disorders such as limb weakness and coordination difficulties are common, with about 60% of patients experiencing gait instability or ataxia. Sensory abnormalities such as tingling or numbness typically occur in the extremities.
Based on the characteristics of the disease course, it can be divided into four types: relapsing-remitting (85%), secondary progressive, primary progressive, and progressive-relapsing. Symptoms may partially recover during remission, but myelin damage may gradually accumulate, leading to irreversible damage. About 15% of patients will develop a progressive course, experiencing progressive cognitive dysfunction or bladder control issues.
Diagnosis requires the exclusion of other neurological diseases and typically involves detailed medical history collection and neurological examination. Magnetic Resonance Imaging (MRI) is a key tool that can reveal multiple lesions in the brain and spinal cord. If oligoclonal bands or abnormal IgG indices are found in cerebrospinal fluid analysis, it can strengthen the diagnosis.
It is necessary to differentiate from neuromyelitis optica, Lyme disease, and vitamin B12 deficiency. In cases of subacute disease progression, it may be necessary to monitor for more than six months before a definitive diagnosis can be made. The latest diagnostic criteria emphasize that MRI images must show characteristics of "time and space dissemination," meaning that MRI scans at different time points must show lesions in different locations.
Disease-modifying therapies (DMTs) are the core treatment, with first-line medications including β-interferon injections and glatiramer acetate. Second-line potent therapies such as natalizumab and ocrelizumab are suitable for patients with highly active disease courses. New oral medications like siponimod can penetrate the blood-brain barrier to reduce the formation of brain lesions.
Targeted treatments include the use of 4-aminopyridine to improve nerve conduction abnormalities, antidepressants to alleviate fatigue, and physical therapy to improve muscle stiffness. For bladder issues, α-receptor blockers may be used, and patients with severe spinal cord lesions may require epidural spinal stimulation.
Currently, there is no way to completely prevent this disease, but the risk can be reduced through the following methods:
Recent studies suggest that early exposure to ultraviolet B (UVB) sunlight may modulate immune responses, but excessive exposure should be avoided to reduce the risk of skin cancer.
If the following symptoms occur, immediate medical attention should be sought: unilateral vision loss lasting more than 48 hours, unilateral limb weakness lasting more than 72 hours, sudden onset of gait instability preventing independent walking. Early diagnosis can be confirmed through MRI to assess the number and location of lesions, and a complete evaluation is recommended within two weeks of the first onset of symptoms.
If a diagnosed patient's symptoms suddenly worsen or new neurological deficits occur, they should seek medical evaluation immediately to determine if treatment adjustments are necessary. Pregnant patients experiencing symptom worsening should adjust medication use under the joint monitoring of obstetric and neurology specialists.
Physical therapists can improve mobility through balance training and strength enhancement, and home environments should incorporate non-slip designs and assistive devices. Patients can reduce fatigue by completing tasks in segments and using assistive tools, and regularly adjusting rehabilitation plans with the healthcare team to adapt to changes in their condition is essential.
What types of medications are currently available for treating multiple sclerosis? How are they chosen?Modification therapy medications are categorized into interferons, monoclonal antibodies, etc., to slow disease progression; symptomatic treatments target individual issues such as spasms and pain. Physicians will choose the most suitable treatment combination based on the type of onset, disease progression, and personalized factors such as patient age and pregnancy needs.
What are the benefits of regular exercise for patients with multiple sclerosis? What should be noted?Moderate exercise can improve balance, delay muscle atrophy, and alleviate anxiety and depression. It is recommended to choose low-impact activities such as aquatic exercise or yoga, and to avoid high-temperature environments and excessive fatigue, adjusting exercise intensity under the guidance of a professional rehabilitation therapist.
What psychological challenges do patients commonly face after diagnosis? How can they cope?Common emotional issues include anxiety about the uncertainty of the disease course and feelings of loss regarding changes in social roles. It is recommended to participate in patient support groups, undergo cognitive-behavioral therapy, and discuss the use of anti-anxiety medications with physicians, as establishing a stable social support network is crucial.
How can the risk of relapses be reduced? What special attention should be paid in daily life?Regular use of disease-modifying therapy medications can reduce the frequency of relapses, and patients should avoid infections, excessive stress, and maintain normal calcium and sodium levels. Daily monitoring of symptom changes, maintaining a regular routine, and increasing communication frequency with the healthcare team during weather changes or signs of infection are important.
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